Days alive and out of hospital after enhanced recovery video-assisted thoracoscopic surgery lobectomy

Abstract

OBJECTIVES Days alive and out of hospital (DAOH) integrates overall information of hospitalization, readmissions, and mortality that have been applied as a new outcome measure. However, DAOH after video-assisted thoracoscopic surgery (VATS) in an established enhanced recovery after surgery (ERAS) programme has not been reported. METHODS Patients aged ≥18 years with non-small-cell lung cancer undergoing VATS lobectomy in an established ERAS programme were eligible. The primary and secondary outcomes were DAOH during the first postoperative 365 days and reasons for reduced DAOH. RESULTS A total of 316 consecutive patients with well-defined inclusion criteria and complete follow-up were assessed retrospectively. The median length of stay was 3 days (IQR 2–6). The medians (IQR) of postoperative 30, 60, 90, 180 and 365 DAOH were 27 (22–28), 57 (51–58), 86 (80–88), 176 (169–178) and 359 (349–363) days, respectively. Air leak was the dominant factor for reduced DAOH from postoperative day (POD) 0–30 (47.2%) and 0–365 (38.3%). Side effects of adjuvant chemotherapy were dominant from POD 31–60 and 61–90 (23.5% and 47.1%) and recurrence/metastases from POD 91–180 and 181–365 (25.6% and 50.0%). A low diffusing capacity for carbon monoxide (odds ratios 1.28, 95% confidence interval 1.07–1.53; P=0.007) and prior surgical history (odds ratios 1.80, 95% confidence interval 1.08–2.99; P=0.023) were predictors for low DAOH. CONCLUSIONS DAOH after 1 year with an established VATS lobectomy ERAS programme was only reduced with a median of 6 days. The main factors reducing DAOH were air leak, adjuvant chemotherapy and recurrence. DAOH may be an important patient-centred outcome to define future improvement strategies.

Heart rate variability after video-assisted thoracoscopic surgery lobectomy

“…We found that indices measuring overall variability of the heart rate (SDNN and TP) were markedly reduced after VATS lobectomy, especially in the day-and nighttime, showing only slight signs of returning towards baseline at the end of the study 9 days after surgery. This cohort seemed to be a representative sample of the patients treated at our institution, as they were similar to a previous larger cohort [14].…”

“…While the most important reason for prolonged hospital stay after VATS is air leak, other key reasons are: pain, pneumonia, and PoAF [11,14]. Preoperative HRV has shown promise in predicting pain, pneumonia, and PoAF in preliminary studies, in other surgical settings including thoracic surgery [1,15], and has been associated with differing trajectories of molecular in ammatory responses following abdominal surgery, including higher CRP in the group of patients with lower short-term variation [19], suggesting an association between in ammation and HRV changes.…”

Lung cancer surgery in Denmark

“…DAOH integrates overall information of hospitalisation, readmission, and mortality and as such may be important for defining future improvement strategies with the patient in focus. After implementation of ERAS median DAOH after one year postoperatively was 359 days (15).…”

Anaesthesia role in enhanced recovery after surgery: a revolution in care outcomes

“…Patient-centred care remains at the very heart of ERAS pathways, and patient-reported measures (such as Quality of Recovery Score-15 or WHO Disability Assessment Schedule 2.0 at 30 and 90 days after surgery) become important [21]. A recently described patient-centred outcome measurement is days alive and out of hospital within a specified time frame (30, 60, 90, 180 days or 1 year) and has recently been used to assess video-assisted thoracoscopic surgery within an ERAS programme [22].…”